Attorneys general in several states have filed lawsuits against the law. Can those legal actions block reform?
The state lawsuits challenge the law’s requirement for individuals to buy health insurance. Moffit of the Heritage Foundation calls that requirement an unprecedented expansion of congressional power. Yet many legal experts think that the states’ suits have little chance of success. “A state cannot sue the federal government to have a federal law invalidated,” says Timothy Jost, a professor at Washington and Lee University School of Law. Individuals’ lawsuits over paying a penalty could get more traction. But Jost says that Congress “can do anything it wants as long as it’s regulating economic activity. This is clearly economic activity.” Mark Hall of Wake Forest University School of Law says, “There’s not a constitutional right to be uninsured. ... It’s hard to argue that Congress can’t regulate it in this way.”
Can reform be repealed if Republicans gain control of both houses of Congress?
It’s an uphill climb for reform opponents. First, they must seize control of both houses. Then, if the president vetoes a repeal bill - and President Obama assuredly will -- Republicans must command a two-thirds congressional majority to override the veto. But if a Republican wins the presidency in 2012 or in 2016, repeal of health reform becomes more possible. Under that scenario, they would need a filibuster-proof 60 votes to junk the law entirely. But short of 60, Republicans with a Senate majority could still cut off or delay funding for implementation of reform provisions. Reform opponents with a majority “can always make trouble for the president,” Jost says.
Will insurance premiums go up or down when reform is fully implemented?
It depends on who’s buying the coverage. People purchasing individual insurance may indeed face a higher cost when exchanges are launched four years from now. But they will receive much better benefits coverage, Duke’s Taylor says. Those already in large employer plans may not see much change beyond the current climb in their premiums related to rising medical costs, not reform, says Collins of the Commonwealth Fund.
Will illegal immigrants be given the opportunity to buy health insurance in the new exchanges?
Illegal immigrants will be barred both from getting subsidies to buy coverage and from participating in the new insurance exchanges that will begin in 2014, even if they pay the entire cost out of their own pocket. Undocumented immigrants will continue to get care at some community clinics and will still be able to receive emergency medical treatment at hospital ERs.
Does reform represent a government takeover of the health care system?
Certainly government will have a bigger role under reform. The law provides a large expansion of Medicaid, a government insurance program for the poor and disabled. And there is more government regulation of insurance in general. “It’s a remarkable expansion of federal power,” Moffit says. Still, it’s not a government-run system. The private insurance market will be preserved in the new insurance exchanges, and large employers will continue to run their own health plans. “People will have more protections,”says Collins of the Commonwealth Fund.